Provider Demographics
NPI:1700022258
Name:ST.LOUIS-DUDLEY, ZENOVA ROBIN (LPN)
Entity Type:Individual
Prefix:
First Name:ZENOVA
Middle Name:ROBIN
Last Name:ST.LOUIS-DUDLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SCOTT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-3929
Mailing Address - Country:US
Mailing Address - Phone:518-632-5065
Mailing Address - Fax:
Practice Address - Street 1:305 SCOTT HILL RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-3929
Practice Address - Country:US
Practice Address - Phone:518-632-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222521-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse